“Treating older patients who have malignant brain cancer with the chemotherapy drug temozolomide plus a short course of radiation therapy extends survival by two months compared to treating with radiation alone, show clinical trial results published in the New England Journal of Medicine.
“For 45% of the study participants, improved survival almost doubled — from 7 months to 13.5 months, says co-principal investigator Normand Laperriere, radiation oncologist at Princess Margaret Cancer Centre, University Health Network. This was linked to a molecular marker that indicated if a DNA repair mechanism against the drug was active. When the mechanism was ‘off,’ tumours responded better to treatment.”
“In the first study evaluating patient-reported cosmetic outcomes in a population-based cohort of older women with breast cancer, The University of Texas MD Anderson Cancer Center researchers found that less radiation was associated with improved cosmetic satisfaction long-term. However, reduced radiation was also associated with a slightly increased risk of disease recurrence.
“The findings, presented at the 2016 San Antonio Breast Cancer Symposium in a poster session by Cameron W. Swanick, M.D., should serve as an important discussion point between older patients and their physicians when making treatment decisions.”
“Patients aged 65 years and older are living longer after lung cancer surgery, and with older people representing a rapidly growing proportion of patients diagnosed with lung cancer, this improved survival is especially significant, according to an article posted online today by The Annals of Thoracic Surgery.
“The American Cancer Society estimates that the median age at diagnosis for lung cancer is 70, supporting the premise that lung cancer is predominantly a disease of the elderly. Despite this, older patients with cancer are generally under-represented in clinical cancer trials, including those for lung cancer. This makes the study by Felix G. Fernandez, MD, from the Emory Clinic in Atlanta, and colleagues particularly important.”
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“Chemoradiotherapy (CRT) is associated with survival benefit over chemotherapy (CT) alone for elderly patients with limited-stage small-cell lung cancer, according to a study published online Oct. 19 in the Journal of Clinical Oncology.
“Christopher D. Corso, M.D., Ph.D., from the Yale University School of Medicine in New Haven, Conn., and colleagues examined outcomes for elderly patients (≥70 years) treated with CT versus CRT. Data were included for 8,637 patients with limited-stage small-cell lung cancer in the National Cancer Data Base between 2003 and 2011.
“The researchers found that 43.7 and 56.3 percent of the patients received CT and CRT, respectively. CRT receipt was less likely with increasing age, clinical stage III disease, female sex, and the presence of medical comorbidities (all P < 0.01). Compared with CT, CRT use correlated with increased overall survival on univariate and multivariate analysis (median overall survival, 15.6 versus 9.3 months). Survival benefit associated with CRT was confirmed in a propensity score-matched cohort of 6,856 patients (hazard ratio, 0.52; P < 0.001). In subset analysis, patients who were alive at four months after diagnosis had a survival benefit with concurrent versus sequential CRT (median overall survival, 17.0 versus 15.4 months; log-rank P = 0.01).”
“In a position statement published online July 20 in the Journal of Clinical Oncology, the American Society of Clinical Oncology has called on the U.S. government and the cancer research community to broaden clinical trials to include older adults.
” ‘Older people living with cancer often have different experiences and outcomes in their treatment than younger cancer patients,’ Julie Vose, M.D., M.B.A., society president, said in a news release from the group. ‘As we age, for example, the risk of adverse reactions from treatment significantly increases. Older adults must be involved in clinical trials so we can learn the best way to treat older cancer patients, resulting in improved outcomes and manageable toxicity,’ she explained.
“More than 60 percent of cancers in the United States occur in people aged 65 and older, the statement authors say, noting the number of seniors will increase in coming years. However, there is a lack of evidence about cancer treatments for the elderly because too few are included in clinical trials, and clinical trials designed specifically for seniors are rare.”
“Three out of four older men with low-risk prostate cancer opted for active surveillance during a 4-year period ending in 2013, according a large prostate cancer database.
“After bottoming out at 22% during 2000 through 2004, active surveillance was the initial option for newly diagnosed low-risk prostate cancer among men 75 or older from 2010 through 2013.
“Rates of active surveillance among men of all ages mirrored those of the older subgroup but remained much lower overall. From 1990 through 2009, the proportion of men in the 10,472-patient cohort entering active surveillance ranged from 6.7% to 14.3%. The rate increased sharply from 2010 to 2013, topping out at 40.4%, as reported online in JAMA.
” ‘In this analysis of a longstanding national registry, we found that after years of overtreatment for patients with low-risk prostate cancer, rates of active surveillance/watchful waiting for low-risk disease increased sharply in 2010 through 2013,’ Matthew R. Cooperberg, MD, and Peter R. Carroll, MD, of the University of California San Francisco, wrote in conclusion.”
“Women with luminal A subtype breast cancer – and particularly those older than 60 – may not need radiation treatment if they are already taking hormone therapy, shows clinical research led by radiation oncologists at the Princess Margaret Cancer Centre published online today in the Journal of Clinical Oncology.
“The findings potentially advance delivery of personalized cancer medicine for up to 25% of women diagnosed with breast cancer in North America every year, say co-principal investigators Dr. Fei-Fei Liu, Chief, Radiation Medicine, and Dr. Anthony Fyles, staff radiation oncologist. Dr. Liu is Chair, Department of Radiation Oncology, University of Toronto, where Dr. Fyles is also a Professor. In Ontario alone, they estimate, this could save the provincial health care system up to $3 million annually. Drs. Liu and Fyles talk about their research at https://www.youtube.com/watch?v=mrl5-1gsoSg .
“They stress, however: ‘For all other breast cancer subtypes, radiation therapy is definitely of benefit and the required treatment.’
Drs. Liu and Fyles examined tumour specimens from participants in a prior randomized clinical trial who received either tamoxifen (hormone therapy) plus whole-breast radiation therapy, or only tamoxifen.”
“A retrospective study found that early-stage non–small-cell lung cancer (NSCLC) patients over 70 years old derive a similar benefit as younger patients from adjuvant chemotherapy following surgical resection. This suggests that age should not preclude patients from receiving adjuvant chemotherapy.
“ ‘Studies conducted in the last decade have provided evidence that adjuvant chemotherapy after surgical resection improves outcomes for patients with resected stages II and IIIA disease and selected patients with stage I (large tumor size) NSCLC,’ wrote study authors led by Apar Kishor Ganti, MD, of the University of Nebraska Medical Center in Omaha. These studies, however, have not focused specifically on elderly patients, and NSCLC has a median age of 70 years at diagnosis.
“The new study was a population-based retrospective review of 7,593 patients with stage IB to stage III NSCLC who underwent surgical resection; 2,897 (38%) were aged at least 70 years. Results of the study were published online ahead of print in Cancer.
“Among the younger patients, 31.6% received adjuvant chemotherapy, while only 15.3% of the older patients received this treatment (P .0001). Both groups saw changes in rates of adjuvant chemotherapy over time, though of different magnitudes: 9.3% of younger patients diagnosed between 2001 and 2003 received adjuvant chemotherapy, which rose by 27.8% by 2009 to 2011. In older patients, the rate was 4.5% in the earlier period and increased by 16.0%. The most common chemotherapy option used in all patients (64.6%) was carboplatin-based doublets.”
“Previous research by the study’s lead author Grace Lu-Yao, PhD, MPH, cancer epidemiologist at the Cancer Institute of New Jersey and professor of medicine at Rutgers Robert Wood Johnson Medical School, and colleagues examined 10-year outcomes for this population (JAMA, Vol. 302, No. 11). The 2009 research showed men diagnosed with prostate cancer beginning in the early 1990’s had significantly improved survival compared with patients whose cancers were diagnosed in prior decades. Given the protracted nature of the disease and increasing longevity among elderly men, 10-year follow-up may not be sufficient to make informed treatment decisions. Dr. Lu-Yao notes this new study, which extends data examination by an additional five years, ‘helps provide a more complete picture of potential outcomes for patients who have a life expectancy greater than 10 years.’
“The new research, which appears in the current online edition of European Urology (doi: 10.1016/j.eururo.2015.03.021), examined 33,137 Medicare patients aged 65 or older who were diagnosed with early-stage (T1 or T2) prostate cancer from 1992 through 2009 and received conservative management (no surgery, radiotherapy, cryotherapy or androgen deprivation therapy) within the first six months of diagnosis. The researchers utilized information from the Surveillance, Epidemiology and End Results (SEER) cancer registries and Medicare claims. All SEER registries hold the highest level of certification of data quality.
“Investigators found that men aged 64 to 74 with a Gleason score (a grading system that indicates how likely a tumor will spread) of between five and seven had a lower risk (5.7 percent) of dying from prostate cancer over a 15-year period as compared to men 75 and older, whose risk was 10.1 percent. For men with the highest level Gleason scores (between eight and 10), 15-year prostate cancer mortality rates were 22 percent for men aged 65 to 74 and 27 percent for men 75 and older.”